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The transition to value-based care One of the more signifi cant challenges facing healthcare organizations is managing, under increasing pressure, to lower cost and improve quality while being paid largely on a fee-for-service basis. It is likely that a meaningful transi- tion to value-based reimbursement will take a number of years, and that organizations will be required to practice in “the gap,” under misaligned incentives and with competing priorities. T ere are many high-level, multi-step proposals for win- ning strategies to manage the transition from fee for service to fee for value. Steps range from the relatively concrete (eliminate waste) to the abstract (collaborate) with virtu- ally unlimited permutations between. Each step has merit. Each, however, is real work that will need to be done in ad- dition to managing a traditional fee-for-service organization through pervasive regulatory requirements, reimbursement compression and rising administrative costs. T e answer to managing an organization through “the

gap” may be found by borrowing an approach used by elite musicians and athletes called “deliberate practice.” Deliber- ate practice means choosing a very small part of your skill set and consciously working at your skills until you are unconsciously competent. Applied to a healthcare organiza- tion, this implies choosing a single, meaningful step toward value-based care and focusing on it until the organization is unconsciously competent – until it is automatic. Here’s a great place to start: Deliberately practice a step, such as calculating cost, profi t and loss per service or service line. T at step is both helpful in resolving a fee-for-service pain point and core to delivering value-based care.

ized any shared savings, and two owed Medicare $4 million, leading to an exodus of nearly one-third of the pioneers from the program after the inaugural year. What led to such a turbulent start? Not surprisingly, data sharing, communication and patient facilitation were noted as some of the largest obstacles to developing meaningful savings. Before considering a move to an ACO, healthcare executives should evaluate a few key tenets of the techno- logical geography of the patient population, including the capabilities and enthusiasm for current legacy systems, the use of patient portals and electronic communication, and the penetration of mobile and smartphone technology. Unlike prior attempts of consolidating care, the preserva- tion of patient choice and physician independence within an ACO precludes the classic one-size-fi ts-all, top-down approach to information systems. Any solution must work alongside existing legacy systems, patient and physician portals, and function seamlessly on preferred devices (smartphone, tablet, desktop). Any less will result in a loss of patient and physician enthusiasm and a loss of savings.

Adam Kaufman, Ph.D., president and CEO, DPS Health

Online interventions key to effective behavior change, health improvements Today, it is more crucial than ever that we provide

Zachary Landman, M.D., chief medical offi cer, DoctorBase

ACO obstacles Since the Medicare Shared Savings Program established the guidelines for the creation of ACOs in 2011, they have been touted as the instruments to fundamentally disrupt unsustainable growth in healthcare spending. T rough the conversion of fee for service to fee for value, healthcare pro- viders can be incentivized to focus on population health and reduce unnecessary high-cost services, resulting in shared savings between payers and providers. Of the 32 chosen as the initial pioneers of the program, however, only 13 real-

relevant and meaningful programs to help reestablish and support healthy habits and lifestyles. In particular, online programs have proven to increase physical activity, improve nutrition, support patient self-management and eff ectively manage chronic diseases. For group practices and hospitals, online interven- tions accomplish this by extending their reach beyond the boundaries of the offi ce or hospital. Participation in a 24/7 online self-management support program deepens the relationship between the provider organization and the patient, and expands the relationship and engagement into the daily lives of patients, even when they are not taking part in in-person care. Additionally, it’s estimated that for many patients, self-care plays a greater role in health and health outcomes than medical care. Providers can promote and support self-care through online programs that serve to complement and improve their own eff orts in a cost- eff ective manner. Technology-enabled online services, such as Virtual Lifestyle Management (VLM) from DPS Health, facilitate patient-clinical communications by addressing patients’ needs. Patients are at the center of their own journey to healthier lifestyles over an extended 12-month period. Programs that focus on patient behaviors and lifestyle pro- vide support within the context of patients’ everyday lives and for things that are important to them, such as diet and